Interactions with Ephedra

While no specific drug interactions have been reported for the herb, the active ingredients of ephedra, ephedrine and pseudoephedrine, have several documented interactions with monoamine oxidase inhibitors (Dingemanse 1993; Dingemanse et al. 1996); tricyclic antidepressants (Boada et al. 1999); narcotic analgesics (Dambisya et al. 1991); antihypertensive medications (particularly clonidine) (Goyagi et al. 1998; Hayakawa-Fujii et al. 1999); xanthine derivatives such as theophylline and caffeine (Bahner et al. 1993; Dawson et al. 1995; Heiss and Podreka 1978); aspirin (Horton and Geissler 1991); and amphetamine-derivatives (Clarkson and Thompson 1997). The isolation of individual ingredients from a complex compound is not necessarily equivalent to testing the complete product; however, for safety, it is important to assume that interactions with the herb may be similar.

Ephedra should not be used with prescription or over the counter medications containing ephedrine, pseudoephedrine, or phenylpropanolamine, which are ingredients found commonly in nasal decongestants and weight loss products.

References

Bahner DR, Frenia ML, Augenstein WL. Theophylline toxicity from an over-the-counter preparation. J Emerg Med. 1993;11:427-430.

Boada S, Solsona B, Papaceit J, Saludes J, Rull M. Hypotension refractory to ephedrine after sympathetic blockade in a patient on long-term therapy with tricyclic antidepressants [in Spanish]. Rev Esp Anestesiol Reanim. 1999;46(8):364-366.

Clarkson PM, Thompson HS. Drugs and sport. Research findings and limitations. Sports Med. 1997;24(6):366-384.

Dambisya YM, Wong CL, Chan K. Ephedrine and phenylpropanolamine potentiate the lethal toxicity of morphine and codeine in naīve mice. Asia Pacific J Pharmacol. 1991;6(3):255-258.

Dawson JK, Earnshaw SM, Graham CS. Dangerous monoamine oxidase inhibitor interactions are still occurring in the 1990s. J Accid Emerg Med. 1995;12(1):49-51.

Dingemanse J. An update of recent moclobemide interaction data. Int Clin Psychopharmacol. 1993;7(3&4):167-180.

Dingemanse J, Guentert T, Gieschke R, Stabl M. Modification of the cardiovascular effects of ephedrine by the reversible monoamine oxidase A—inhibitor moclobemide. J Cardiovasc Pharmacol. 1996;28:856-861.

Goyagi T, Tanaka M, Nishikawa T. Oral clonidine premedication enhances the pressor response to ephedrine during spinal anesthesia. Anesth Analg. 1998;87(6):1336-1339.

Hayakawa-Fujii Y, Iida H, Dohi S. Propofol anesthesia enhances pressor response to ephedrine in patients given clonidine. Anesth Analg. 1999;89(1):37-41.

Heiss WD, Podreka I. Assessment of pharmacological effects on cerebral blood flow. Eur Neurol. 1978;17(Suppl. 1):135-143.

Horton TJ, Geissler CA. Aspirin potentiates the effect of ephedrine on the thermogenic response to a meal in obese but not lean women. Int J Obes. 1991;15:359-366.

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